Diabetic retinopathy can damage the blood vessels that supply the retina and, in advanced stages, may cause abnormal blood vessels to grow on or around the retina. These fragile vessels can bleed into the vitreous, the clear gel that fills the inside of the eye, causing a condition called vitreous haemorrhage.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
When the bleeding is significant or does not clear on its own, vitrectomy may be considered to remove the blood and treat the underlying retinal problem.
Vitrectomy is not required for every person with diabetic retinopathy or vitreous haemorrhage. The decision depends on the severity and cause of the bleeding, the condition of the retina, how much vision is affected and whether other treatments are appropriate.
For a broader overview of vitrectomy and the conditions it can treat, see the Vitrectomy page.
How Does Diabetic Retinopathy Cause Vitreous Haemorrhage?
Diabetic retinopathy develops when prolonged high blood sugar levels damage the small blood vessels in the retina. As the disease progresses, the retina may not receive enough oxygen, encouraging the growth of abnormal new blood vessels.
These new vessels are fragile and can bleed easily. If blood enters the vitreous cavity, it can block or scatter light before it reaches the retina, resulting in blurred vision or a sudden loss of vision.
The bleeding may be mild, causing floaters or hazy vision, or it can be extensive enough to significantly reduce vision in the affected eye.
What Is Vitreous Haemorrhage?
Vitreous haemorrhage occurs when blood enters the vitreous, the gel-like substance between the lens and retina. In people with advanced diabetic retinopathy, bleeding can occur when abnormal retinal blood vessels rupture. Common symptoms may include:
- Sudden blurred or reduced vision
- Dark spots or shadows in the field of vision
- New floaters
- Hazy or cloudy vision
- A sudden change in vision in one eye
The amount of vision lost depends on how much blood is present and where it is located. A small amount of bleeding may cause floaters, while a large haemorrhage can significantly obstruct vision.
When Is Vitrectomy Considered for Diabetic Retinopathy?
Vitrectomy may be considered when diabetic retinopathy has caused complications that cannot be adequately managed with other treatments or when the bleeding or retinal damage is significantly affecting the eye.
Depending on the individual situation, surgery may be considered when:
- A vitreous haemorrhage is severe or does not clear adequately.
- Blood inside the vitreous prevents the ophthalmologist from examining or treating the retina properly.
- Scar tissue has developed and is pulling on the retina.
- Tractional retinal detachment is present or developing.
- Abnormal blood vessels or fibrous tissue require surgical treatment.
- There are other advanced complications of proliferative diabetic retinopathy.
The decision is based on the condition of the individual eye rather than simply on the presence of diabetic retinopathy.
How Does Vitrectomy Treat Vitreous Haemorrhage?
During vitrectomy, the surgeon removes some or all of the vitreous gel from inside the eye. When blood has entered the vitreous, removing the blood-filled gel can clear the visual pathway and allow the surgeon to see the retina more clearly.
The procedure may also allow the surgeon to address the underlying cause of the bleeding. Depending on the retinal condition, additional treatments such as laser treatment may be performed during the same surgery. In some cases, a gas bubble or silicone oil may be placed inside the eye to support the retina while it heals.
Why Is Treating the Underlying Diabetic Retinopathy Important?
Removing blood from the vitreous can improve the clarity of the eye, but it does not by itself eliminate the underlying diabetic retinal disease.
Advanced diabetic retinopathy can continue to cause abnormal blood vessel growth, bleeding or scar tissue formation if it is not appropriately managed.
For this reason, vitrectomy may be combined with other treatments aimed at controlling the retinal changes caused by diabetes.
Laser treatment may be used to treat areas of abnormal retinal blood vessel growth, while injections of medicines into the eye may be recommended in some situations. The treatment plan depends on the specific retinal changes present.
What Happens During Vitrectomy for Diabetic Retinopathy?
The exact procedure varies according to the severity of the disease and the complications affecting the eye. In general, the surgeon makes very small openings in the eye and uses specialised instruments to remove the vitreous.
If there is blood inside the vitreous, the blood-filled material can be removed. The surgeon can then examine the retina more clearly and treat problems such as abnormal blood vessels, scar tissue or retinal traction.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Additional procedures may be performed when necessary. These can include laser treatment or other techniques to address retinal complications.
At the end of surgery, the surgeon may leave the eye filled with a clear fluid, gas or silicone oil depending on what is needed to support recovery.
Can Vitrectomy Restore Vision After Vitreous Haemorrhage?
Vision may improve after vitrectomy for vitreous haemorrhage, particularly when the blood inside the eye was a major cause of the visual disturbance. Removing the blood-filled vitreous can clear the pathway through which light reaches the retina.
However, the amount of visual improvement depends on the condition of the retina. Diabetic retinopathy can cause damage beyond the bleeding itself, including retinal swelling, abnormal blood vessel growth and scar tissue formation.
If the retina or macula has already sustained permanent damage, removing the vitreous haemorrhage may not completely restore normal vision.
Visual recovery can also take time after surgery. If a gas bubble has been placed inside the eye, vision may remain significantly blurred until the bubble gradually disappears.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Happens If Vitreous Haemorrhage Does Not Require Surgery?
Not every vitreous haemorrhage requires immediate vitrectomy. In some cases, the blood may gradually clear on its own, allowing vision to improve without surgery.
The decision to observe or operate depends on factors such as the severity of the haemorrhage, whether the retina can be adequately examined, the cause of the bleeding and whether there are other retinal complications.
Regular ophthalmic follow-up is important because diabetic retinopathy can continue to progress even if the initial bleeding settles.
What Are the Risks of Vitrectomy for Diabetic Retinopathy?
Vitrectomy is an established retinal procedure, but it carries potential risks. The risks can vary depending on the severity of diabetic retinopathy and the complexity of the surgery.
Possible complications include:
- Cataract development or progression
- Changes in eye pressure
- Bleeding inside the eye
- Retinal tear or retinal detachment
- Infection
- Inflammation
- Macular swelling
- Recurrent vitreous haemorrhage
- The need for additional retinal surgery
People with advanced diabetic retinopathy may require close monitoring even after successful surgery because the underlying retinal disease can continue to affect the eye.
Can Vitreous Haemorrhage Happen Again After Vitrectomy?
Yes, recurrent bleeding can occur in some patients, particularly when the underlying diabetic retinopathy remains active.
Vitrectomy removes the blood-filled vitreous and allows the surgeon to treat retinal abnormalities, but it does not permanently remove the effects of diabetes on the retinal blood vessels.
Further treatment may therefore be needed to control abnormal blood vessel growth or other retinal changes. Regular follow-up helps the ophthalmologist monitor the eye and identify recurrent problems.
How Does Diabetes Management Affect Eye Health?
Managing diabetes is an important part of protecting the eyes over the long term. Blood sugar levels, blood pressure and other factors can influence the progression of diabetic complications.
Eye treatment and diabetes management work together. Even after vitrectomy or other retinal treatment, continued monitoring of diabetes and regular eye examinations remain important.
Your ophthalmologist and diabetes-care team can advise you on the monitoring and treatment appropriate for your individual situation.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
What Is Recovery Like After Vitrectomy?
Recovery varies depending on the extent of diabetic retinal disease and the type of surgery performed. Vision may initially be blurred, and the eye may feel uncomfortable or appear red while healing.
If a gas bubble is used, vision can remain significantly blurred until the bubble gradually disappears. Patients may also receive specific positioning instructions depending on the surgical findings and the type of retinal support used.
It is important to follow the postoperative instructions provided by your ophthalmologist, use prescribed eye drops as directed and attend follow-up appointments.
If a gas bubble has been placed in the eye, your doctor will also provide specific instructions about air travel and changes in altitude. These precautions are important because changes in atmospheric pressure can cause certain gas bubbles to expand.
The Bottom Line
Vitrectomy can play an important role in treating advanced diabetic retinopathy and vitreous haemorrhage, particularly when bleeding does not clear adequately or when abnormal blood vessels, scar tissue or retinal traction are affecting the eye.
The procedure can remove blood from the vitreous and give the surgeon access to the retina for additional treatment when needed. Vision may improve after surgery, but the outcome depends largely on the extent of retinal and macular damage caused by diabetic retinopathy.
Vitrectomy does not eliminate the underlying effects of diabetes on the retina. Continued eye examinations, appropriate management of diabetes and regular follow-up with an ophthalmologist remain important after treatment.
